Contact Us

How Can We Help You?

If you have comments, questions and concerns, or would like more information on Easter Seals services, please contact us by filling out the form below.

Your e-mail will be answered within two to three business days.

You can also reach Easter Seals Northern Ohio at:

440.324.6600 (voice)
440.324.6602 (fax)

Or, via regular mail at:

41641 North Ridge Road, Suite D
Elyria, Ohio 44035

Please enter your contact information below. Required fields are marked with an asterisk.

If you have previously registered, please login here to prepopulate your information.


	Title:
*	First Name: Required
*	Last Name: Required
*	Email Required
	Street 1:
	Street 2:
	City:
	State / Province:
*	ZIP / Postal Code: Required
	Country:
	Phone Number:
	Yes, I would like to receive email from Easterseals
	Keep me logged in. What's this? Remembers your login information for your convenience. Use only on trusted, private computers. Privacy Policy

*2.

Question - Required - How did you learn about our Web site?

Question - Not Required - I am a primary caregiver for a child/children:

Question - Not Required - I am a primary caregiver for an aging parent:

Question - Not Required - I have a disability or someone close to me has a disability:

Question - Not Required - Someone close to me or a family member is living with autism:

Question - Not Required - I am/was in the United States Armed Forces or someone close to me is/was:

*8.

Question - Required - Questions/Comments

(Maximum response 255 chars, approx. 5 rows of text)